Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0700X | Prosthodontist | 24510 | TX |
Y | 1223P0700X | Prosthodontist | 6466-015 | WI |
NPI | 1033482500 |
---|---|
Provider Name | Rupal Suresh Vasani |
First Address | Chippewa Falls, WI 54729-1422 |
Second Address | Chippewa Falls, WI 54729-1422 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2012 |
Last Update Date | 14/02/2012 |